Prenatal care for illegal immigrants divides Nebraska lawmakers

June 1, 2012
Medical Ethics Advisor
LexisNexis News

Prenatal care for illegal immigrants divides Nebraska lawmakers

Illegal immigration and health care have been mentioned a great deal in the news recently, and the issue has Nebraska's lawmakers at odds. Some conservatives are supporting a plan to offer state aid to pregnant women in the United States illegally.

The measure being put before Nebraska lawmakers requires the state to pay for prenatal care to low-income women who have entered the United States illegally, and also extend coverage to an estimated 1,162 fetuses each year, at a cost of $650,000 in state money and $1.9 million in federal tax dollars.

The measure has made opponents of normal typical allies, with Republican Gov. Dave Heineman pushing hard against the proposal, even while noting his strong opposition to abortion. The Republican speaker of the Legislature, Mike Flood, has taken the opposite position, supporting the measure while stating that he has always been against illegal immigration.

When the measure advanced through with the required votes, Heineman singled out Flood, saying he and other lawmakers were wrong to support taxpayer-funded benefits to illegal immigrants, regardless of the reason.

"Unless you and the legislature reverse course, the legacy of this session will be one in which illegals were given preferential treatment over legal Nebraska citizens," Heineman said, reading from a letter that his staff hand-delivered to the speaker's office. "This will be a session remembered for a tax increase on legal, working Nebraskan men and women, while illegal aliens were provided taxpayer-funded benefits."

Flood, who has sponsored legislation banning late-term abortions, said the immigration concern is important but trumped by the health concerns for unborn children who lack access to prenatal vitamins, ultrasounds, doctors, and nurses. He said medical data do not support the notion that pregnant illegal immigrants would move to a state for prenatal care.

Abortion opponents said the vote marked an important victory to assuage their fears about the health of unborn children, and the prospect that women without access to care could seek abortions.

Supporters argue that by helping women have a healthy pregnancy, the state would reduce infant deaths and, ultimately, save money by avoiding emergency births, long hospital stays, and treatment for children who develop complications. Opponents say the bill would reward unlawful behavior with taxpayer-funded benefits, and could attract more illegal immigrants to Nebraska. Opponents said the money is needed elsewhere.

Nebraska Right to Life, the state's largest pro-life group, issued a statement calling on six pro-life senators who voted "no" on LB 599 to switch and support the bill.

Heineman and other opponents of LB 599 have said the issue is illegal immigration, not the rights of the unborn. "This is an issue of fairness," the governor said in a statement. "Hard-working Nebraskans pay their taxes and obey the laws. Illegal aliens who don't pay taxes and don't obey the laws should not be receiving taxpayer-funded benefits."

Exact counts vary on how many states now provide taxpayer-financed prenatal care. The governor, citing a check by the Nebraska Department of Health and Human Services of federal Medicaid statistics, said 14 states cover the unborn children of undocumented women through the Children's Health Insurance Program: Arkansas, California, Illinois, Louisiana, Massachusetts, Michigan, Minnesota, Oklahoma, Oregon, Rhode Island, Tennessee, Texas, Washington, and Wisconsin.

The Children's Health Insurance Program uses a combination of state and federal funds. The Kaiser Family Foundation additionally lists New York, New Jersey, and Washington, D.C., as having state-funded prenatal programs.

The National Immigration Law Center says there are 13 states and Washington, D.C. Advocates for LB 599 said the studies they are aware of discount any magnet effect, the concern noted by Heineman.

Detainees' health care

A 2000 study,1 "Health care use among undocumented Latino immigrants," surveyed immigrants who settled in Texas and California cities. Respondents said jobs and family led them to settle in those cities. Another study, "The integration of immigrant families in the United States," released in 2001, concluded that jobs, and not generous social safety nets, prompted immigrants to settle where they did.

That study also concluded that illegal immigrant families grew four times faster in states that offered less-generous public benefits than in those offering relatively ample safety nets, because more jobs were available.

For every $1 invested in prenatal care, studies indicate a savings of between $1.70 and $3.38 by reducing neonatal complications, according to the National Conference of State Legislatures.2

Providing quality health care to illegal immigrants who are being detained in Immigration and Customs Enforcement's (ICE) custody is an important and challenging task, says assistant director for ICE Health Service Corps (IHSC) Jon Krohmer, MD, FACEP, in a statement.

The ICE Office of Enforcement and Removal Operations (ERO) ensures the safe and humane conditions of confinement for illegal immigrants detained in ICE custody. This includes the provision of reliable, consistent, and appropriate health services.

IHSC, which falls under ERO, is comprised of more than 900 Public Health Service-commissioned officers, federal civil servants, and contract support staff. Their mission is straightforward: to serve as the medical authority for ICE on a wide range of medical issues, including the agency's comprehensive detainee health care program, according to DHS officials.

However, at this point, only estimated costs for this health care program are available, and vary between $50 million and $150 million per year.

IHSC provides direct care to approximately 15,000 detainees housed at 21 IHSC-designated facilities throughout the nation. In addition, IHSC oversees the medical care provided to an additional 17,000 detainees at non-IHSC staffed detention facilities across the country. Whenever necessary, it authorizes and pays for off-site specialty and emergency care, consultations, and case management, according to ICE.

"A detainee's health care begins the moment they walk through the facility's doors," said Dr. Krohmer. "Within the first 12 hours of their admission, all detainees undergo a preliminary health screening, which includes an evaluation of the individual's medical, dental, and mental health status, and within the next 14 days, a more detailed physical examination takes place."

Because so many of these detainees are either new arrivals in the country or haven't had access to health care in the past, Dr. Krohmer said it is not unusual for serious health problems to be diagnosed at these screenings.

"We're finding out about health issues that even they didn't even know about, and, in most cases, are able to begin treatment," he said.

However, some observers find Dr. Krohmer's findings disturbing.

"I'm more concerned with illegal aliens who may enter the U.S. carrying a serious — even deadly — disease that may be highly contagious. Why don't IHSC physicians and medical staff concentrate on screening immigrants coming from nations that may have serious health problems?" asks former NYPD police officer and emergency medical technician Nick D'Amato.

The continuity of care not only lasts during the individual's period of detention, but also throughout their removal to their country of origin. Before any detainee boards a plane to be removed from the United States, the detainee must first undergo an evaluation to make sure he or she is fit to fly, according to officials.

In order to continually upgrade the quality of medical services they deliver, IHSC not only actively complies with the Performance Based National Detention Standards, but is also instrumental in the standards' continuous upgrades and improvements. "My staff and I are aware that detainee health care is an ever-evolving issue, and that just like in the general population, health care priorities are constantly changing," said Dr. Krohmer. "We are working to develop a more systematic approach to our health care system within the detention facilities."

For instance, ICE recently streamlined the treatment authorization request. This application — used to formally request a specialized medical procedure that falls outside the scope of what IHSC can provide — is now typically reviewed and approved within 24 hours.

Krohmer added that plans are underway to forge a more uniform health care system among the IHSC facilities, enabling them to work together more cohesively.

"Sounds to me like illegal aliens are getting better health care than American citizens who are poor or homeless and can only receive emergency medical treatment at hospitals. It's a disgrace," said Mike Baker, a political strategist and attorney.

"Sounds to me like illegal aliens are getting better health care than American citizens who are poor or homeless and can only receive emergency medical treatment at hospitals. It's a disgrace," said Mike Baker, a political strategist and attorney.

Do we all know someone that has lost their job and health care that can not afford to seek medical treatment when they are ill or can no longer afford their meds? I know several, too bad they are not illegal aliens.

Nebraska legislators handed the governor a political defeat by overriding his veto of a bill that forced conservatives to chose among conflicting priorities, such as care for the unborn, illegal immigrants and even fiscal austerity.

On the final day of the state’s legislative session Wednesday, lawmakers in the single-chamber, nonpartisan house overrode the governor’s veto of a prenatal health bill for illegal immigrants in a narrow 30-16 vote with three present but not voting. Lawmakers also got the needed 30 votes to override another veto of a bill dealing with sales tax increases.

“Today, the majority of the Nebraska Legislature decided their priorities are providing taxpayer-funded benefits to illegal immigrants and increasing the sales tax rate on the citizens of Nebraska,” Gov. Dave Heineman said in a prepared statement after the votes. “I strongly disagree with their decisions. Providing preferential treatment to illegals while increasing taxes on legal Nebraska citizens is misguided, misplaced and inappropriate.”

On a policy level, the issue is fairly straightforward, even if the politics of ideology can be complicated.

In 2010, the federal government ordered Nebraska to stop offering prenatal care benefits through Medicaid, the program offering healthcare for the poor. About 870 illegal immigrants and 750 legal residents lost coverage, but the recent bill restores that help by shifting the payments to the Children’s Health Insurance Program.

The payments for the prenatal care would reportedly cost an estimated $650,000 in state money and $1.9 million in federal tax dollars. Supporters of the measure argue that a lack of prenatal care can lead to developmental problems that cost far more in treatment costs than the expense of providing prenatal care -- a frequent argument in any healthcare debate.

The politics of the issue are a bit more confusing. Protecting unborn fetuses would seem to be a conservative priority, but with more than half of the pregnant women in Nebraska being illegal immigrants, two conservative ideals seem to be in conflict.

For Mike Flood, speaker of the chamber and a Republican, like the governor, the key issue was caring for fetuses. Flood, a leading abortion opponent, argued that the babies will be U.S. citizens and that prenatal care is consistent with opposition to abortion.

“If I'm going to stand up in the Legislature and protect babies at 20 weeks from abortion, and hordes of senators and citizens are going to stand behind me, and that's pro-life, then I'm going to be pro-life when it's tough, too,” Flood argued Wednesday night, according to the Associated Press.

“Most Nebraskans and I agree, we support prenatal care, but in the case of illegal immigrants, it should be done by churches, private organizations, charities, private individuals -- not the use of taxpayer funds,” Heineman stated.